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Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysisстатья
Статья опубликована в высокорейтинговом журнале
Статья опубликована в журнале из списка Web of Science и/или ScopusДата последнего поиска статьи во внешних источниках: 10 августа 2021 г.
- Авторы: Huijben Jilske A., JA Wiegers Eveline, F Lingsma Hester, Citerio Giuseppe, IR Maas Andrew, K Menon David, Ercole Ari, Nelson David, Mathieu van der Jagt, W Steyerberg Ewout, Helbok Raimund, Lecky Fiona, Peul Wilco, Birg Tatiana, Zoerle Tommaso, Carbonara Marco, Stocchetti Nino, investigators CENTER-TBI, participants
- Журнал: Intensive Care Medicine
- Номер: 46(5)
- Год издания: 2020
- Издательство: Springer Verlag
- Местоположение издательства: Germany
- Первая страница: 995
- Последняя страница: 1004
- DOI: 10.1007/s00134-020-05965-z.
- Аннотация: PURPOSE: To describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers. METHODS: This is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers. RESULTS: A total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13-15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p < 0.001), use of intracranial pressure (ICP) monitoring (MOR = 2.5, p < 0.001) and aggressive treatments (MOR = 2.9, p < 0.001); and smaller in 6-month outcome (MOR = 1.2, p = 0.01). CONCLUSIONS: Half of contemporary TBI patients at the ICU have mild to moderate head injury. Substantial between-center variations exist in ICU stay and treatment policies, and less so in outcome. It remains unclear whether admission of short-stay patients represents appropriate prudence or inappropriate use of clinical resources.
- Добавил в систему: Бирг Татьяна Михайловна